Epidemiology and Real-World Issues of Elderly Patients With Chronic Heart Failure in Super-Aging Society

Heart failure (HF) is a disease of the elderly. The population aged ≥65 y.o. now accounts for 27.3% in Japan and it will reach 30% in 2025. Furthermore, the prevalence of HF becomes greater with increasing age; 13–14% of the population aged ≥80 y.o. has HF in the United States. HF is a major and growing public health problem in Japan indeed, with high morbidity, mortality, and cost. There is no distinct definition of “elderly” worldwide, but many Japanese people think it is ≥75 y.o and ≥85 years is often classified as “very elderly”. “Elderly” and “very elderly” HF patients are more likely to be female, having higher ejection fraction, increased prevalence of co-morbidities, including atrial fibrillation, hypertension cerebrovascular disease, anemia, malignancy, and chronic kidney disease. Furthermore, risk assessment should also consider conditions such as frailty, impaired functional status, disability, and dementia. Although such populations represent the majority of HF patients and demonstrate worse outcomes compared with younger patients, epidemiological findings and targeted treatment strategies have been insufficiently clarified. Furthermore, financial problems and other social issues including the limited proper patients management by their infrequent referral to cardiologists might affect the proper treatment in such patients. We must share a common strategy for treatment and care to realize the community-based integrated care systems in Japan.